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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2l 5-92)
INSTRUCTIONS: See reverse side lor /iling instructions.
FORM YEAR
10
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❑ Have a beneficial inierest in the entity that is liable for the propeAy taxes on the property-and that owns the property or is buying under a wntract.
- �CONTRACT RECORDED -
I buying on contract ee Simple ownels name �
Recorders of(xe where conVact is recorded � Recortl number P e
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� PROPERTY DESCRIPTION
Counry Township Ta�cing district (city, town, fownshipJ
a i number /Le�g/al d�escription
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It any portion of the resitlential siructure or Ne land not exceeding one (1) acre thal immediately sunowWS that sWCture is used to p uce i me, tlescribe ihe use and portion of
the pmDerry utilizetl to produce income.
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- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry � Township
S e of daimant �
_reby certify the above statements are true, wrrect and complete.
Address (numberana sfreet, dry;i (ate, ZIP code)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatery (��
surrounding resideniial improvements.
Otherland (2)
Total land Qine 1 plus line 2) (3)
Dwellinq (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements Qine 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, conect, and Signamre o( Pssewr Date signed
complete.
Veritying action - Signature of AuOimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead � r�
Valuation or 52,000
Signature ol Auditor Date signed
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